C Kaoutzanis, C J Pannucci, D Sherick
Department of Plastic and Reconstructive Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI 48106, USA. ckaoutzanis@gmail.com
Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2013 JulRectovaginal fistula is a rare but debilitating complication of a variety of pelvic operations. Management remains challenging with high incidence of failure. The majority of patients eventually require surgical intervention. Several surgical procedures have been described including local repair, muscle transposition, or laparotomy. Among the muscles used for rectovaginal fistula repair, the gracilis muscle interposition flap is an excellent option. However, in a small percentage of cases it fails, and alternative techniques should be entertained. We describe the case of a 50-year-old female who underwent stapled hemorrhoidopexy that was complicated by a 30 mm rectovaginal fistula, and required fecal diversion. Four months later, gracilis muscle interposition flap was performed but failed. The right gracilis flap was then re-used successfully as a "walking" flap. At three months the patient underwent closure of the temporary loop ileostomy, and continues to do well with no evidence of rectovaginal fistula recurrence one year later. To our knowledge, this is the first report of the use of a gracilis muscle as a "walking" flap for repair of a rectovaginal fistula, and should be considered as an alternative appropriate treatment for persistent rectovaginal fistulas after failure of initial gracilis muscle interposition flap. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
C Kaoutzanis, C J Pannucci, D Sherick. Use of gracilis muscle as a "walking" flap for repair of a rectovaginal fistula. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 2013 Jul;66(7):e197-200
PMID: 23523165
View Full Text